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Observation
Insurer
Member
Ineligible members have insurance cover
(age, working hours)
•
Financial risk of claims paid to ineligible
members
•
Receiving too much in premiums (may have
to be repaid if error is discovered)
•
Future claim may be denied
•
Paying premiums for cover which should not
be in place
•
May have taken out an individual policy if
had known they were not covered
Eligible members are found not to have
insurance cover
•
Insurer missing out on premiums
•
Member not covered when
could be
Member insurance cover is lower than it
should be
•
Insurer missing out on premiums
•
In the event of a payout on the incorrect
amount, the member’s beneficiaries will be
financially disadvantaged
•
The member is paying lower premiums than
would be expected
Member insurance cover is higher than it
should be
•
Insurer carrying unexpected risk
•
Insurer receiving higher premiums than they
should
•
Member paying higher premiums
Premiums deducted are too high for the
level of insured cover
•
Insurer receiving higher premiums than they
should be
•
Member paying too much for the cover they
have
Premiums deducted are too low for the level
of insured cover
•
Insurer missing out on premiums
•
In low volume or low margin contracts this
could have a significant impact on re-rating
•
Member not paying sufficient premiums
•
Cover as reported to members may be
challenged and a lower amount paid out
Duplicate memberships with a fund
•
Insurer receiving double the premiums
•
Two sums insured for the same member
•
Member paying double the premiums
•
At claim time, the insurer will most likely
identify that a duplicate claim is being made
and will only consider one of the claims
Incorrect key data fields such as date of
birth and gender
•
If the insurance contract has an age or
gender basis, all premiums and cover levels
are in doubt
•
If the insurance contract has an age or
gender basis, all premiums and cover levels
are in doubt
The following
table shows
how particular
insurance
data errors
might impact
stakeholders.
Superfunds November 2016